STANDARDS OF CARE - MEDICAL

While most of us cannot know all the intricacies of medical
science, all the extremely detailed research on the most
up-to-date care, we can have a general understanding of the
standards of care. Physicians are licensed in each State to
practice medicine. While the standards of care vary for each
specialty within medicine, each physician is required to maintain
professional competence, to act honestly and with integrity, to
fully inform patients about all treatment options, and to
actually provide care that meets the standards of care. The
general idea is that all physicians must provide the care which
could reasonably be expected from any competent physician under
the specific circumstances of the case. There are generally
accepted protocols of acting for almost every situation which may
arise in medicine.

If you are using hospice services, the Attending Physician is
required to meet the standards of care in hospice, even if the
Attending Physician is not a hospice specialist. Providing
adequate and appropriate medications to relieve any and all
symptoms the patient may be experiencing is expected. The
clear standard is that the care provided must actually be
adequate to meet the needs of the patient and the family. The
hospice medical director is specifically required to intervene if
the patient's own physician does not provide the necessary
care to meet the patient's needs. Please note that even
though this is a requirement, it does NOT always
happen!

Certain hospices arrange that the hospice medical director
takes over completely when the patient is enrolled in hospice.
This is not how the hospice regulations envision hospice to be
provided! The attending physician can remain the physician who is
making the medical orders, while the hospice medical director
should serve as a "check" on the attending physician
should there be difficulty in getting good symptom control. By
removing the attending physician from the picture, some
"rogue" hospices are allowed to violate standards of
care without the knowledge of the attending physician who would
not agree with such violations. It is important to insist that
your loved one's own attending physician remain the physician
who writes the orders. The hospice does not have the authority or
right to force you to give up the attending physician.

One of the most important standards for hospice is to make a
good-faith effort to do one's best to control pain and
uncomfortable symptoms during the dying process. Narcotic
medications, sedatives and other medications may be used to
achieve this goal. However, leaving the patient in pain without
intervening is one of the most serious violations of hospice care
standards. That's why one should be able to retain access to
both the attending physician and the hospice medical director,
for with two physicians, you have a greater chance of achieving
the goal of symptom relief. Of course, it is sometimes difficult
to achieve full pain control immediately, and different dosages,
medications or treatments may be necessary to reach full
relief.